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It's a life-threatening disease and topic of discussion that most men "sweep under the rugs." If they have it, they don't talk about it, and they don't bother to allow the doctor to perform the simple check to see if it's developing to catch it at the earliest stage so that it can be treated. When it comes to prostate cancer, most men adopt a don't ask, don't tell strategy. They see the disease as their "shame" because they view it as a threat to their "manhood."
"For a long time, associated with prostate cancer has been erectile dysfunction which means that the man either can't, or has problems performing with his wife on an [intimate] basis," says Valentine "Val" Maura, a member of US Too, a prostate cancer education and support group member. "Also, a lot of men don't get examined because they know they have to take a digital rectal exam (DRE), and when a doctor says you have to drop your pants, most men have all kinds of trepidation. Because of that examination, most men wait until it's kind of late."
Maura himself is one of those men who did not have his first prostate examination until late in life. His first check was performed at age 55. Doctors usually recommend that men without familial history have the exam performed for the first time at age 40, for the disease that occurs when cells in the prostate gland grow out of control. Most men have no early symptoms of prostate cancer, but some have urinary symptoms and discomfort.
"I wanted to know what my situation was and I was eager to find out what my condition was," says Maura of the first time he had his prostate examined. As soon as I got near the examination room I got a little chicken myself," said the 62-year-old. "I was real apprehensive when I found out what it entailed, but I said I had come that far and the only way I would find out my condition was to actually be examined."
Maura did the test and received a clean bill of health on his prostate. With his relief he said came questions and concerns as to whether the examination had been properly done and whether he was really safe. He has had his prostate checked every year since. Although he's not a survivor, he's one of those men willing to stand up and promote the awareness of this life-threatening disease most men shy away from speaking about, because they don't want people to know.
"I became interested in cancer some years ago, in the embryonic stage of the Cancer Society some years ago -- and I don't know if I have an inquiring mind, or a wavering mind -- but if I get involved in something, I like to know about it as much as possible. I don't like to just be a member."
As Us Too celebrates Prostate Cancer Awareness Month during September, and a decade as an organization, Maura says there is a lot more openness about the disease and the test to check for prostate cancer because men like himself and a few brave survivors have been talking about it, but he says there needs to be more talk among men. To encourage that much-needed chat, Us Too will stage its third 1,000-man walk for prostate health on Saturday, September 17 behind the theme "Man to Man, Hand to Hand, Foot to Foot, Mouth to Ear, Communicating Each Other's Prostate Concern." It's the Us Too organization's hope that as the men traverse the walk together they begin to talk together about the disease.
While more men talk about the prostate cancer today than they did 10 years ago, Maura says more communication is still needed about the disease that was once thought of as an old man's disease.
Prostate cancer screening statistics by Us Too over the last five years have for the most part increased during prostate screening clinics staged by the organization as the awareness improved. In 2003, their statistics show a total of 313 persons were tested. In 2004, the number dropped to 231, then again in 2005 to 227. In 2006, a total of 481 persons were tested during the clinics, with 373 presenting in 2007. In 2008, a record 771 tests were performed with 624 prostates checked in 2009, and last year, 687 men presented to have their prostates checked.
Statistics also show that most men reported that they took the test at the urging of their wives. In 2004, two men said their wives encouraged them to take the test. Last year statistics complied by Us Too show that 192 men said they had been encouraged to take the test by their spouses.
Maura says the information now suggests that men should have their prostate checked as early as 35, especially if they have a family history. He says prostate cancer is a disease that can be treated and men don't have to die from it if it's caught early enough.
"Men are worried about their manhood, but aren't doing much, or waiting too late to take the requisite steps to protect the very thing that could destroy their manhood," he says.
With several tests to detect prostate cancer the DRE is an early test to screen for the disease when it is most treatable. Maura say Us Too touts the DRE as it measures the degree of enlargement that a prostate has undergone and medical professionals are able to detect textural changes. A Prostate-Specific Antigen (PSA) Blood Test can be done in conjunction to the DRE.
"The PSA test alone won't be able to tell you what condition the prostate is in, because it has no way of measuring the degree of enlargement the prostate has undergone. There have been studies done that show that the PSA itself has no way of measuring what is happening to the prostate, so you could be falsely feeling safe or you could be way off the mark. The DRE measures the degree of enlargement the prostate has undergone and it has a certain texture that it develops because of the enlargement and so therefore you need both to tell you the true picture, because you can have an elevated PSA count, but it cannot tell you what is actually happening with the prostate itself."
Although not a prostate cancer survivor, Maura says checking your prostate is an overall health concern and that younger men who don't take care of their prostates now will suffer from it later.
"A lot of people think when you get prostate cancer it automatically progresses to stage four and you die, but that's not the case, there's a process where it becomes an embarrassment, it becomes painful, it becomes everything before you eventually die. Men tend to want to protect their manhood, but they're dealing with the very source of their manhood."
While there are no warning signs or symptoms of early prostate cancer, once a malignant tumor causes the prostate gland to swell significantly, or once cancer spreads beyond the prostate, men may have a frequent need to urinate, especially at night; difficulty starting or stopping a stream of urine; a weak or interrupted urinary stream; inability to urinate standing up; painful or burning sensation during urination or ejaculation or blood in their urine or semen. While not symptoms of the cancer itself, they are symptoms of the blockage from the cancer growth within the prostate and surrounding tissues.
Symptoms of advanced prostate cancer include dull, incessant deep pain or stiffness in the pelvis, lower back, ribs or upper thighs; arthritic pain in the bones of those areas. Loss of weight and appetite, fatigue nausea or vomiting, swelling of the lower extremities and weakness or paralysis in the lower limbs.
Maura says he knows of people who are undergoing prostate cancer treatment who have finally come to the realization that they are not going to die and that the disease is not fatal necessarily.
"They now find that because they're undergoing the treatment, they're looking at it much better. They still haven't been brave enough to speak about it in a public forum but they have at least come to grips with the fact that they don't have to die. Some are recovering from the surgery, some only have one or two more regimens of chemotherapy and radiation and are realizing it's a whole different ball game than the death knell they thought it was when they first found out."
Maura says too many men are worried about their manhood so they don't talk about prostate cancer, but he says not talking about it is the thing that could destroy their manhood.
During Prostate Cancer Awareness Month, Us Too will host prostate cancer screening clinics during the month on Tuesday, September 20 at the Elizabeth Estates Clinic, on Thursday, September 22 at the Flamingo Gardens Clinic, on Tuesday, September 27 at the South Beach Clinic and on Thursday, September 29 at the Fleming Street Clinic.
A frequent need to urinate, especially at night.
Difficulty starting or stopping a stream of urine.
A weak or interrupted urinary stream.
Inability to urinate standing up.
A painful or burning sensation during urination or ejaculation.
Blood in urine or semen.
These are not symptoms of the cancer itself. Instead, they are the symptoms of the blockage from the cancer growth within the prostate and surrounding tissues.
ADVANCED PROSTATE CANCER SYMPTOMS
Dull, incessant deep pain or stiffness in the pelvis, lower back, ribs, or upper thighs; arthritic pain in the bones of those areas.
Loss of weight and appetite, fatigue, nausea, or vomiting.
Swelling of the lower extremities.
Weakness or paralysis in the lower limbs.
WHEN TO SEEK MEDICAL CARE
Difficulty initiating and/or stopping a urine stream.
Pain on urination.
Pain on ejaculation.
If he'd had a choice between contracting the Human Immunodeficiency Virus (HIV) or developing kidney failure, Marcellus Miller, an eight-year dialysis patient said having the HIV virus would be a much more attractive option. This may sound alarming, but the 38-year-old believes that life with HIV is much better because he believes it at least offers a quality of life that kidney failure does not.
Miller said many people do not fully understand to what extent being on dialysis indefinitely means and that it more or less ends your life.
"No matter what you do or how healthy you may try to be, being on dialysis will take its toll and your life is definitely in limbo. On the other hand [with] HIV/AIDS, although there is a stigma attached to it and it has its downfalls, it doesn't stop life if you take care of yourself. You at least have a greater chance of living a normal and unhindered life as long as you stay on the recommended medication and remain healthy. On dialysis you are not so lucky. You can do everything to the moon and back and you can still just die due to complications or with no warning at all."
Knowing that his heart could fail, or that he could go from feeling great to awful in a split second is a scary prospect that he has to live with daily.
It took him a long time to come to terms with the many lifestyle changes he had to endure due to having kidney failure and being forced to use a hemodialysis machine to have his blood cleaned.
Developing kidney failure was not a surprise to Miller. Because he was diagnosed with type 1 diabetes at the age of seven, he grew up knowing that he would probably have to face issues like an enlarged heart, blindness or kidney failure one day.
"My doctors actually were surprised at how long it took to happen since I was about 30-years-old when my kidneys just gave out. So I knew it would come and I would just have to make changes but how much it would affect my life never really hit me until it happened."
When it happened though, he was still not mentally prepared. Adjusting to dialysis and his new life was hard for him. He described it as traumatizing. The young man who had always been on the go, continued his world travels for a year after his diagnosis as he attempted to continue with his normal.
"At first, I missed out on a lot of dialysis sessions. I still traveled as usual and would attempt to do dialysis in another country when I could. I don't think I paid attention to my diet as well as I should've at first either. It was such a big adjustment for me. It took me getting tired of feeling deathly sick, and spending so much money to do dialysis in another country for me to just say that I had enough. I knew I had to slow down and fully grasp what was happening to me after a while."
He started to take care of his health and tried to do what he knew was best. He watched his diet, and committed himself to his four-hour long three-days per week dialysis treatments at the Princess Margaret Hospital.
No joking matter
Kidney failure is nothing to joke about and why people should pay attention to their health, said nephrologist Dr. Ronald Knowles. He said most kidney failure can be prevented, or at least put off until much later in life, but that many people do not take it seriously until it is too late in most cases.
"Most people are under the misconception that kidneys only do one thing - filter toxins from the blood, but this is not so. Kidneys actually are essential for three main things in the body. They remove toxins that accumulate in the blood. They regulate the body's water content which is important because without it you can bloat excessively, [and] they also work to control blood pressure and certain mineral levels within the body like sodium, potassium and calcium. Without these organs (kidneys) a person is prone to further health problems and death."
Most people attribute kidney damage and failure to not drinking enough water on a daily basis. Although the lack of fluid intake is a contributing factor, the leading causes of kidney failure are uncontrolled high blood pressure and diabetes, according to the doctor. And these two chronic conditions are responsible for at least 80 percent of the kidney damage and failure in Bahamians.
"Diabetes and hypertension are two conditions popular in our country and this wouldn't be so bad if people did what they had to do to regulate them, but they don't for the most part. This is why we have so many people who are suffering from kidney failure."
The medical professional urged people to remain vigilant about their health.
"If you are monitoring your blood pressure, it should be less than 135/85. A controlled blood sugar level is less than seven percent when a [hemoglobin A1c] test is done. A regular urine analysis is not enough anymore because it's not the most accurate in determining blood sugar levels. I think it is important to do things the best way you can so you know what just what is going on in your body."
Eat your fruits and vegetables
To ensure one's kidneys are in the best health, eating fruits and vegetables regularly is key. Cutting back on salts and eliminating fast foods as much as possible is also important. Also, keeping up with exercising, drinking adequate water daily and doing an annual physical is a good addition to your health regimen.
Even if you do all of that, there are still some people who will develop kidney damage and eventually failure, said the doctor. In those cases, he said it's usually an inherited defect or due to other health related problems that overtax the kidneys and shut them down. No matter how someone developed kidney failure, Dr. Knowles said there are ways to deal with the problem and that someone with kidney failure does not have to feel like their life is over and that they have to give up everything.
There are three main options for people with kidney failure - a kidney transplant, hemodialysis and peritoneal dialysis.
The best treatment is always a kidney transplant, said Dr. Knowles, but transplants are usually hard to get if a patient does not have a relative who is compatible and willing to give a kidney.
Hemodialysis, the form of treatment most people are familiar with is a good option to use until a transplant can be performed. Hemodialysis requires patients to visit a clinic three times a week for four hours each time in order to cleanse the blood of toxins by using a dialysis machine. The third option, peritoneal dialysis, is a good way to go for patients requiring more freedom and not minding a more hands-on experience with their dialysis treatments. It is a personal dialysis procedure in which the patient undergoes a minor surgery to insert a catheter or permanent tube in the stomach. This allows fluids to be introduced into the stomach and then toxins like urea and excess glucose from the body diffuse across the peritoneum - a layer in abdomen - to be drained out later. The process usually needs to happen three or more times a day. The doctor said this option is good for people with busy lives who don't have the time to visit a medical facility three times a week. It does have a downside because people with the catheter are likely to get infections at least once a year because of it.
"While there are ways to deal with this problem (kidney failure), people do have a higher likelihood to live shortened lives. This is due to other health related problems that arise due to their kidney disease and failure. Most people with kidney failure tend to die from heart disease later on and it happens so quickly it is unexpected," said the nephrologist.
"But if one is healthy and their own ailment is kidney problems, they have a possibility of living 20-plus years after commencing treatment and staying healthy. The reason other people can die a week or months into treatment is usually due to other ongoing problems like poorly regulated diabetes, hypertension, pre-existing heart conditions or other chronic ailments. Having kidney disease and doing dialysis only adds to the strain on the body and this can eventually lead to early death in the long run. Even so, I encourage all persons to just stay positive and be as healthy as possible. Kidney disease is only one of the many problems that exist due to poor health, so this is not the only problem to look out for," said the doctor.
Not an easy road
Miller said dealing with his kidney failure and dialysis has not been easy and that he misses many of the things he used to do, but that he's happy he is doing better and that he's actually now doing what is right.
"Having something like kidney failure really makes you see things in a new light. You realize what is most important from what isn't. I have definitely grown closer to God and just learned to laugh at life and myself a lot more. It's not an easy road but it is one that you have to make the best of," he said.
He encouraged people who have to undergo dialysis to find support in family members and in other people who are going through the same thing.
"If there was one lesson I have learned in doing dialysis is that you have to keep positive and do all that you can to keep busy. You can't think about yourself anymore and sometimes the only way to get through life at this point is to laugh and just enjoy the small things. I have grown a great sense of humor and a sense of giving that I never had before. To me it's important to just keep on going no matter what."
After eight years of dialysis treatments and sporadic visits to the hospital's emergency room, a ray of hope is being shed on Miller's life. A kidney match has been found for him and he's scheduled for a 2015 transplant. He said it's the best thing he could imagine happening to him and that he was looking forward to living a better quality life in years to come.
Dr. Krista Nottage Is Top Award Winner
Friday, March 2nd, 2012 (Nassau, Bahamas) - Natalie Hernandez is a truly extraordinary young woman. In February 2012, Natalie visited Phnom Pehn, Cambodia as a volunteer student educator for Operation Smile, an international medical charity that has provided more than 2 million patient evaluations and over 200,000 free surgeries for children and young adults born with cleft lips, cleft palates and other facial deformities around the world.
Bahamians are watching a tsunami of chronic non-communicable diseases sweep through its population as coronary artery disease and cardiovascular disease has become the number one cause of death in Bahamians. And unless people decide to act and change their way...
I rise on behalf of the Ministry of Health to make my contribution to this 2010/2011 budget presentation and thank the great constituency of Killarney for the opportunity to present this, my third health budget to this honorable chamber.
I wish to congratulate the Rt. Hon. Prime Minister and Minister of Finance, the Hon. Hubert Alexander Ingraham, for his courage in presenting a Budget that is reflective of the realities of the national economic situation and that refused to defer difficult decisions for future generation of leaders.
Jerome Smith was walking home from a gas station four years ago when a man bashed his head in with a rock, leaving the then 20-year-old clinging to life. It was a day Smith recalls vividly. He said he and a female relative were walking home when a man started shouting jeers at her.go," he said.